Healthcare Provider Details

I. General information

NPI: 1538109855
Provider Name (Legal Business Name): ROY A SCHMIDT M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 STONEBRIDGE BLVD
JACKSON TN
38305-2042
US

IV. Provider business mailing address

15 STONEBRIDGE BLVD
JACKSON TN
38305-2042
US

V. Phone/Fax

Practice location:
  • Phone: 731-660-2056
  • Fax: 731-661-9092
Mailing address:
  • Phone: 731-660-2056
  • Fax: 731-661-9092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD22099
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD22099
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number22099
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: